issue brief MIDWIFERY CARE & BIRTH CENTERS PUBLISHED MAY 2020
As Mississippians cope with a lack of obstetric services in over half of counties in the state, an increasing number of women desire to have less-medicalized births outside of a typical hospital setting. The number of planned births that occurred outside of a hospital in Mississippi grew by 68 percent between 2007 and 2017 as did births attended by midwives. Midwifery care is being explored across the country as a way to alleviate workforce shortages and offer safe, community-based care in low-risk pregnancies.
Midwives are trained professionals who help healthy women during pregnancy, labor and delivery, and after birth. Research indicates that integration of midwifery A BRIEF HISTORY OF MIDWIFERY IN care in a health system and better access to midwives are associated with higher MISSISSIPPI rates of vaginal delivery, vaginal delivery after prior cesarean (c-section), and
In 1927, more than 3,000 lay midwives breastfeeding as well as lower rates of premature births, low birth-weights, and were documented across Mississippi. The neonatal death. While most births that occur in Mississippi are uncomplicated, just mostly black midwives served white women over two percent of pregnancies and births are managed by midwives annually, and black communities with no access to doctors. Many were recruited and trained and few women have access to safe, non-medicalized birth options. as public health nurses by the Department of Health in response to poor public health Midwives have been instrumental in providing uncomplicated pregnancy- and limited access to physicians. By 1975 related care in previous times of provider shortages and poor birth outcomes in only 217 lay midwives were active. Greater availability of physicians and hospital beds, Mississippi. (See sidebar.) Mississippi is currently experiencing a shortage of improved education about medical care, and obstetric providers; women in forty-six Mississippi counties must drive an hour the availability of Medicaid funds for care or more to see an obstetrician (OBGYN) for prenatal, delivery, and post-partum contributed to a shift from home births to hospital-based, medicalized deliveries. care. From 2015 to 2017 Mississippi had the highest rates of cesarean deliveries, pre-term births, and low birth weight in the nation. In response to similar shortages In response to limited capacity at local hospitals and high infant and maternal and poor birth outcomes, several states have broadened access to maternity care mortality rates, the Mississippi State through midwives and birth centers for women with uncomplicated pregnancies. Department of Health developed maternal and child health (MCH) clinics during the 1970s. The clinics employed certified nurse-midwives to provide prenatal care and hospital-based deliveries to low- KEY POINTS income expectant mothers in several counties including Warren, Hinds, Bolivar, Midwives and birth centers provide a model of maternity care that research Washington, Holmes, and Jackson counties. shows can be appropriate for low-risk pregnancies and deliveries with Nurse midwives practicing in the MCH clinics were trained in partnership with the similar or better outcomes as typical obstetric care with lower healthcare University of Mississippi Medical Center. costs. In 1978 nurse midwives conducted over 5,200 visits and delivered 376 infants in Certified Nurse Midwives currently practice in Mississippi hospitals, while Jackson County alone. Certified Professional Midwives and Direct Entry Midwives legally practice unregulated in homes and community settings. There is currently no school of nurse- midwifery in the state, and prenatal care has Birth centers provide midwifery care and operate independently from not been provided in public health clinics since 2017. hospitals. These providers are currently licensable, but none currently operate in Mississippi. Source: Beck, T. (2019). ; Mississippi State Board of Health. (1973-1983). Annual Reports.
1 of 4
Center for Mississippi Health Policy � Brief: Birth Centers and Midwifery Care � May 2020
DRAFT COPY-NOT FOR DISTRIBUTION Midwives as Providers of Maternity Care Three types of midwives are known to practice in Mississippi. Certified Nurse Midwives (CNMs or nurse-midwives), 29 of whom are currently licensed to DOULAS practice and attend over 800 births (or two percent) annually across the state. Doulas, often confused for midwives, act as part of a birth support team and provide non- Other types of midwives in the state include Certified Professional Midwives clinical, emotional support and advocacy for (CPMs) and Direct Entry Midwives (or lay midwives). In Mississippi, CPMs pregnant and laboring women in any setting. and lay midwives practice legally but unregulated, and the number of these practitioners active in the state is unknown. These midwives are available for women who wish to give birth in home-like settings, but no state-level oversight exists.
PERCENTAGE OF BIRTHS ATTENDED BY MIDWIVES TABLE 1. A COMPARISON OF TYPES OF MIDWIVES CURRENTLY PRACTICING IN MISSISSIPPI IN SOUTHEASTERN STATES, 2018